Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Surgery EORE > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

Epidemiology thoracic aortic aneurysm

A

6th-7th decade MALE w/ hx HTN

Ascending aortic aneurysm = MC (60%) - 2/2 cystic medial necrosis

Descending aortic aneurysm (40%) - 2/2 atherosclerosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

CP thoracic aortic aneurysm

A

MC asymptomatic

If compression of local anatomy - back pain, flank pain, abd pain

Cold foot = thromboembolism preventing blood flow to area

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

PE thoracic aortic aneurysm

A

Commonly normal

Rupture = hemorrhagic shock (tachy, dec BP)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Dx thoracic aortic aneurysm

A

CT ANGIOGRAM = best imaging study

MRI if cannot receive contrast for CTA (renal fxn, preggers)

CXR may be first indication of aneurysm if large enough (widened mediastinum)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Treatment aortic aneurysm

A

Medical prevention:

  • Beta-blockers (esp if a/w marfan synd) - decreased HR = limits rate of expansion
  • ACEI/ARB - limit expansion

Surgery indications - catheter guided stent graft placement (closed endovascular repair) IF:
Symptomatic
Ascending > 5.5cm
Descending >6.5 cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Abdominal aortic aneurysm risk factors (6)

A 
Age > 60
HTN
Smoking
Atherosclerosis
Other aneurysms
HLD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

CP AAA

A

**ASX until rupture
Rupture = back pain, flank pain, groin pain

Sudden cold or blue distal extremities - thromboembolism = limb ischemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

PE AAA

A

Vitals normal until rupture - then hemorrhagic shock (tachy, low BP)

ABD: Rupture = palpable pulsatile mass, distension, tenderness

Skin: Rupture = Cullen’s sign (periumbilical bruising) or Turner’s sign (bruising on flank/back)

Sudden cold or blue extremity 2/2 limb ischemia or thromboembolism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Indications for US to screen for AAA (4)

A

ABD ultrasound indicated for:
[1] Men 65-74 YO w/ hx smoking
[2] Siblings or offspring w/ AAA
[3] Pt w/ presence of thoracic AA or peripheral arterial aneurysms
[4] Pt w/ hypermobility syndromes (marfan, ehler-danlos)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Dx AAA

A

Abdominal US = BEST IMAGING STUDY

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What size to we start following AAA closesly? At what size is intervention required?

A

Follow closely > 3cm
Intervene > 5-5.5 cm
(at risk for rupture)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Repair options AAA

A

Open surgery vs closed endovascular repair - closed preferred (lower short term morbidity)- based on anatomy & comorbidities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Follow up s/p repair of AAA

A

Long term surveillance w/ CTA or MRA after endovascular repair

If ruptures before scheduled surgery - has 50% mortality during surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Aortic dissection risk factors (6)

A

Review: dissection = tear in intima separation of intima from media = false lumen

RF: 
[1] HTN
[2] Atherosclerosis
[3] Collagen disorder
[4] Aortic valve replacement
[5] Aortic aneurysm
[6] Cardiac catheterization
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

CP aortic dissection

A

Sudden severe sharp or tearing CP in posterior chest or back pain

HTN

Wide pulse pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Dx aortic dissection

A

Essentials for dx:
[1] clinical presentation c/w dissection
[2] evidence of dissection via imaging:
- CXR - probs the initial study done - will show widened mediastinum
- CTA - BEST IMAGING STUDY

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Initial management of dissection

A

HR and BP control w/ esmolol, pain relief w/ morphine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Management of acute Stanford type A dissection

A

Stanford type A dissection = dissection starts at ASCEND-ing aorta = SURGICAL EMERGENCY

Endovascular (closed) repair vs open repair

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Management of acute Stanford type B dissection

A

Stanford type B dissection = one that starts in descending aorta - less serious than type A

Try to medically manage first - esmolol, pain relief (morphine)

Indications for surgery - aortic rupture, end organ ischemia, continued hemorrhage into pleural or retroperitoneal space, continued HTN/pain despite management, early false lumen expansion, large single entry

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Long term management of aortic dissection

A

Long term medical therapy - minimize aortic wall stress w/ lifelong BB therapy and goal BP <120/80

Serial imaging: 3mo - 6mo- 12mo then q1-2 years after

21
Q

Indications for reoperation after aortic dissection repair

A

Recurrence of dissection
Aneurysm formation
Leakage at anastomosis or stent

22
Q

Sources of arterial EMBOLI in acute limb ischemia 2/2 arterial occlusion?

Sources of arterial THROMBUS?

A

Arterial EMBOLI 2/2
Afib, MI, endocarditis, valvular disease, prosthetic valves

Arterial THROMBUS 2/2: vascular grafts, atherosclerosis, hypercoagulable state, entrapment syndrome, arterial trauma

23
Q

MC vessels affected by arterial thrombus/emboli

A

Femoral 28%
Popliteal 17%

Arm 20%
Aortoiliac 18%

24
Q

Risk factors acute limb ischemia 2/2 arterial occlusion

A 
Afib
Recent MI
DVT
Arterial trauma
Large vessel aneurysm

RF of aortic dissection ([1] HTN [2] Atherosclerosis [3] Collagen disorder [4] Aortic valve replacement [5] Aortic aneurysm [6] Cardiac catheterization)

25
CP acute limb ischemia 2/2 arterial occlusion (6 P's of limb ischemia)
CP depends on course of vessel occlusion, location, and presence or absence of collaterals for blood supply 6 P's: Pain, pallor, paralysis, pulselessness, poikilothermia, paresthesia
26
After how many hours does arterial occlusion result in irreversible damage?
After 6 hours
27
Dx acute limb ischemia 2/2 arterial occlusion
History and PE Ankle brachial index testing - pressure in foot/pressure in arm (foot normally higher than arm). Nl value 1.0-1.4. 0.8-0.9 = some arterial dz. 0.5-0.8 = moderate arterial disease, <0.5 = severe arterial disease Vascular imaging (revascularization may supersede need for imaging study)
28
Indications for ABI (ankle brachial index) testing for PAD (peripheral arterial disease) & when to refer/intervene based on results
Indications: Anyone > 70 YO Every smoker > 50 YO Every diabetic > 50 YO Ankle Brachial Index Results: Nl value 1.0-1.4 0.8-0.9 = some arterial dz - modify risk factors * *0.5-0.8 = moderate arterial disease * *<0.5 = severe arterial disease Refer anyone < 0.9 w/ moderate arterial disease or severe arterial disease to vascular specialist
29
Treatment acute limb ischemia 2/2 arterial occlusion
Emergent or urgent revascularization - Anticoagulation w/ IV heparin Thrombolytic therapy Thrombectomy, embolectomy Endovascular surgery - angioplasty or stent placement Open surgical intervention * * limb loss rate = 30% * *Mortality rate = 20%
30
Follow up care after treatment of acute limb ischemia 2/2 arterial occlusion
Post-revascularization, must look into the cause of the clot
31
Chronic venous disease pathophysiology
Inadequate muscle pump function, incompetent venous valves, elevated venous pressure Venous pooling → edema → ischemia
32
Chronic venous disease types (3)
[1] Telangiectasia - dilated sm superficial veins = MOST COMMON FORM of chronic venous disease [2] Varicose veins - dilated, tortuous superficial veins (MC greater saphenous) [3] Chronic venous insufficiency - edema, skin changes, ulceration
33
CP Chronic venous disease
Leg pain, heaviness, swelling, muscle cramps, tightness, irritation, discoloration, bleeding from varicose veins or telangiectasia
34
PE Chronic venous disease
Pitting edema w/ dorsal pedal hump skin changes - lipodermatosclerosis of the skin w/ discoloration (brawny, hemosiderin color) Ulcers - irregular borders w/ surrounding induration & significant change
35
Dx Chronic venous disease
Venous duplex ultrasound - dx = retrograde flow > 0.5 s in duration (suggests venous reflux)
36
Treatment Chronic venous disease
Compression therapy - compression stockings or unna bot w/ 20-30 mmHg compression Stasis dermatitis - steroid creams Surgery - slcerotherapy, phlebectomy or ligation, laser ablation or radiofrequency ablation
37
Indications for surgical intervention Chronic venous disease (3)
[1] failure of conservative therapy [2] bleeding from dilated veins [3] phlebitis or thrombosis of superficial veins
38
Types of surgical options (3) for chronic venous disease and indications for each
[1] Sclerotherapy - for <4mm diameter veins [2] Phlebectomy or ligation [3] Endovenous laser ablation or readiofrequency ablation - for chronic venous dz of great saphenous vein w /intact deep venous system Summary: SCLEROTHERPY = SMALL VEINS ONLY ABLATION FOR LARGE VEINS (great saphenous)
39
When to refer person w/ Chronic venous disease to specialist
[1] significant saphenous vein reflux [2] open wounds - send to wound clinic/specialist [3] cosmetic concerns
40
PAD: Claudication - RF
``` Age Smoking Male Family hx Homocysteinemia Metabolic syndromes ```
41
PAD: Claudication - pathophys
Claudication = ischemic type pain with exercise (inc demand) due to supply/demand mismatch - relieved by rest Atherosclerosis = MCC - fibromuscular dysplasia = renal artery stenosis, arterial embolism, vasculitis
42
CP PAD: Claudication
Extremity pain Claudication (exertional pain cuased by supply/demand mismatch) Ischemic rest pain (worse dz) Dependent rubor (purple/red color on dependent areas) Non-healing wound or ulcer (no bl flow to site = no healing) Skin discoloration Erectile dysfunction (any pt w/ ED should be screened for PAD)
43
PE PAD: Claudication
Smooth shiny skin, cool skin, pallor, cyanosis, mottling Buerger test - leg elevated 30 deg x 30 sec - turn blue? Lower extremity neuropathy Dec/absent distal pulses Bruits Dry gangrene
44
Classification PAD: Claudication
WIFI classification - Wound, Ischemia, Foot Infection = lower extremity threatened limb loss classification system to assess risk for amputation risk w/in 1 year
45
Dx PAD: Claudication - | 3 techniques/options & 5 essentials for dx
ABI: - Ankle SBP/brachial SBP - Normally Ankle SBP > brachial SBP - Arterial dz = lowers lower ext BP, level lower is proportional to disease severity Arterial duplex US: - assesses pulses/bl flow in arteries CTA/MRI: - helps to localize where artery blockage is Essentials for diagnosis: [1] ischemic rest pain [2] tissue loss [3] ABI < 0.9, [4] abnormal pulse pressure, [5] claudication
46
Treatment PAD: Claudication
Conservative: modify RF, smoking cessation, consistent moderate exercise Medical: ASA & Statin +/- cilostazole (minimizes platelet clotting, improves walking distance) Surgery: Revascularization - angioplasty, stent, endarectomy, open bypass
47
Indications for surgical intervention: PAD: Claudication
Disabling claudication, ischemic rest pain, ulceration, gangrene
48
Types of surgical interventions PAD: Claudication - how to decide based on classification
Surgical revascularization options: Angioplasty, stent, endarterectomy, surgical open bypass Use TASC classification to determine percutaneous vs open surgery A/B lesions - less severe - percutaneous C/D lesions - more severe - require open surgery (endarterectomy or bypass)

Surgery EORE (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions